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Root Cause Analysis of Gastroduodenal Ulceration After Yttrium-90 Radioembolization

  • Clinical Investigation
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Abstract

Introduction

A root cause analysis was performed on the occurrence of gastroduodenal ulceration after hepatic radioembolization (RE). We aimed to identify the risk factors in the treated population and to determine the specific mechanism of nontarget RE in individual cases.

Methods

The records of 247 consecutive patients treated with yttrium-90 RE for primary (n = 90) or metastatic (n = 157) liver cancer using either resin (n = 181) or glass (n = 66) microspheres were reviewed. All patients who developed a biopsy-proven microsphere-induced gastroduodenal ulcer were identified. Univariate and multivariate analyses were performed on baseline parameters and procedural data to determine possible risk factors in the total population. Individual cases were analyzed to ascertain the specific cause, including identification of the culprit vessel(s) leading to extrahepatic deposition of the microspheres.

Results

Eight patients (3.2 %) developed a gastroduodenal ulcer. Stasis during injection was the strongest independent risk factor (p = 0.004), followed by distal origin of the gastroduodenal artery (p = 0.004), young age (p = 0.040), and proximal injection of the microspheres (p = 0.043). Prolonged administrations, pain during administration, whole liver treatment, and use of resin microspheres also showed interrelated trends in multivariate analysis. Retrospective review of intraprocedural and postprocedural imaging showed a probable or possible culprit vessel, each a tiny complex collateral vessel, in seven patients.

Conclusion

Proximal administrations and those resulting in stasis of flow presented increased risk for gastroduodenal ulceration. Patients who had undergone bevacizumab therapy were at high risk for developing stasis.

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Acknowledgments

We thank Jarrett Rosenberg for support with the statistical analysis of the presented data and David Bingham for providing us with an illustration on biopsy histology.

Conflict-of-interest statement

Daniel Sze is on the medical or scientific advisory boards for Surefire Medical, Inc., Treus Medical, Inc., RadGuard Medical, Inc., and Jennerex Biotherapeutics, Inc.; on speaker’s bureau for W. L. Gore, Inc.; and is a consultant for Biocompatibles, Inc. and Sirtex, Inc.

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Authors and Affiliations

  1. Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA

    Marnix G. E. H. Lam, John D. Louie, Mohamed H. K. Abdelmaksoud, Rebecca E. Ennen & Daniel Y. Sze

  2. Department of Radiology and Nuclear Medicine, UMC Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    Marnix G. E. H. Lam

  3. Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA

    Subhas Banerjee

  4. Division of Nuclear Medicine and Molecular Imaging, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA

    Andrei H. Iagaru

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  1. Marnix G. E. H. Lam
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  2. Subhas Banerjee
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  3. John D. Louie
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  4. Mohamed H. K. Abdelmaksoud
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  5. Andrei H. Iagaru
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  6. Rebecca E. Ennen
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  7. Daniel Y. Sze
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Correspondence to Daniel Y. Sze.

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Lam, M.G.E.H., Banerjee, S., Louie, J.D. et al. Root Cause Analysis of Gastroduodenal Ulceration After Yttrium-90 Radioembolization. Cardiovasc Intervent Radiol 36, 1536–1547 (2013). https://doi.org/10.1007/s00270-013-0579-1

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  • DOI: https://doi.org/10.1007/s00270-013-0579-1

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